| NPI | 1861870933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX U0078) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX U0078) | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2022-10-11 |